[Congressional Record Volume 142, Number 114 (Tuesday, July 30, 1996)]
[House]
[Pages H8768-H8776]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          VETERANS' HEALTH CARE ELIGIBILITY REFORM ACT OF 1996

  Mr. STUMP. Mr. Speaker, I move to suspend the rules and pass the bill 
(H.R. 3118) to amend title 38, United States Code, to reform 
eligibility for health care provided by the Department of Veterans 
Affairs, as amended.
  The Clerk read as follows:

                               H.R. 3118

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; REFERENCES TO TITLE 38, UNITED STATES 
                   CODE.

       (a) Short Title.--This Act may be cited as the ``Veterans' 
     Health Care Eligibility Reform Act of 1996''.
       (b) References to Title 38, United States Code.--Except as 
     otherwise expressly provided, whenever in this Act an 
     amendment or repeal is expressed in terms of an amendment to, 
     or repeal of, a section or other provision, the reference 
     shall be considered to be made to a section or other 
     provision of title 38, United States Code.

     SEC. 2. HOSPITAL CARE AND MEDICAL SERVICES.

       (a) Eligibility for Care.--Section 1710(a) is amended by 
     striking out paragraphs (1) and (2) and inserting the 
     following:
       ``(a)(1) The Secretary shall, to the extent and in the 
     amount provided in advance in appropriations Acts for these 
     purposes, provide hospital care and medical services, and may 
     provide nursing home care, which the Secretary determines is 
     needed to any veteran--
       ``(A) with a compensable service-connected disability;
       ``(B) whose discharge or release from active military, 
     naval, or air service was for a compensable disability that 
     was incurred or aggravated in the line of duty;
       ``(C) who is in receipt of, or who, but for a suspension 
     pursuant to section 1151 of this title (or both a suspension 
     and the receipt of retired pay), would be entitled to 
     disability compensation, but only to the extent that such 
     veteran's continuing eligibility for such care is provided 
     for in the judgment or settlement provided for in such 
     section;
       ``(D) who is a former prisoner of war;
       ``(E) of the Mexican border period or of World War I;
       ``(F) who was exposed to a toxic substance, radiation, or 
     environmental hazard, as provided in subsection (e); and
       ``(G) who is unable to defray the expenses of necessary 
     care as determined under section 1722(a) of this title.
       ``(2) In the case of a veteran who is not described in 
     paragraph (1), the Secretary may, to the extent resources and 
     facilities are available and subject to the provisions of 
     subsection (f), furnish hospital care, medical services, and 
     nursing home care which the Secretary determines is 
     needed.''.
       (b) Conforming Amendments.--(1) Section 1710(e) is 
     amended--
       (A) in paragraph (1), by striking out ``hospital care and 
     nursing home care'' in subparagraphs (A), (B), and (C) and 
     inserting in lieu thereof ``hospital care, medical services, 
     and nursing home care'';
       (B) in paragraph (2), by inserting ``and medical services'' 
     after ``Hospital and nursing home care''; and
       (C) by striking out ``subsection (a)(1)(G) of this 
     section'' each place it appears and inserting in lieu thereof 
     ``subsection (a)(1)(F)''.
       (2) Chapter 17 is amended--
       (A) by redesignating subsection (g) of section 1710 as 
     subsection (h); and
       (B) by transferring subsection (f) of section 1712 to 
     section 1710 so as to appear after subsection (f), 
     redesignating such subsection as subsection (g), and amending 
     such subsection by striking out ``section 1710(a)(2) of this 
     title'' in paragraph (1) and inserting in lieu thereof 
     ``subsection (a)(2) of this section''.
       (3) Section 1712 is amended--
       (A) by striking out subsections (a) and (i); and
       (B) by redesignating subsections (b), (c), (d), (h) and 
     (j), as subsections (a), (b), (c), (d), and (e), 
     respectively.

     SEC. 3. PROSTHETICS.

       (a) Eligibility for Prosthetics.--Section 1701(6)(A)(i) is 
     amended--
       (1) by striking out ``(in the case of a person otherwise 
     receiving care or services under this chapter)'' and 
     ``(except under the conditions described in section 
     1712(a)(5)(A) of this title),'';
       (2) by inserting ``(in the case of a person otherwise 
     receiving care or services under this chapter)'' before 
     ``wheelchairs,''; and
       (3) by inserting ``except that the Secretary may not 
     furnish sensori-neural aids other than in accordance with 
     guidelines which the Secretary shall prescribe,'' after 
     ``reasonable and necessary,''.
       (b) Regulations.--Not later than 30 days after the date of 
     the enactment of this Act, the Secretary of Veterans Affairs 
     shall prescribe the guidelines required by the amendments 
     made by subsection (a) and shall furnish a copy of those 
     guidelines to the Committees on Veterans' Affairs of the 
     Senate and House of Representatives.

     SEC. 4. MANAGEMENT OF HEALTH CARE.

       (a) In General.--(1) Chapter 17 is amended by inserting 
     after section 1704 the following new sections:

     ``Sec. 1705. Management of health care: patient enrollment 
       system

       ``(a) In managing the provision of hospital care and 
     medical services under section 1710(a)(1) of this title, the 
     Secretary, in accordance with regulations the Secretary shall 
     prescribe, shall establish and operate a system of annual 
     patient enrollment. The Secretary shall manage the enrollment 
     of veterans in accordance with the following priorities, in 
     the order listed:
       ``(1) Veterans with service-connected disabilities rated 30 
     percent or greater.
       ``(2) Veterans who are former prisoners of war and veterans 
     with service-connected disabilities rated 10 percent or 20 
     percent.
       ``(3) Veterans who are in receipt of increased pension 
     based on a need of regular aid and attendance or by reason of 
     being permanently housebound and other veterans who are 
     catastrophically disabled.
       ``(4) Veterans not covered by paragraphs (1) through (3) 
     who are unable to defray the expenses of necessary care as 
     determined under section 1722(a) of this title.
       ``(5) All other veterans eligible for hospital care, 
     medical services, and nursing home care under section 
     1710(a)(1) of this title.
       ``(b) In the design of an enrollment system under 
     subsection (a), the Secretary--
       ``(1) shall ensure that the system will be managed in a 
     manner to ensure that the provision of care to enrollees is 
     timely and acceptable in quality;
       ``(2) may establish additional priorities within each 
     priority group specified in subsection (a), as the Secretary 
     determines necessary; and
       ``(3) may provide for exceptions to the specified 
     priorities where dictated by compelling medical reasons.

     ``Sec. 1706. Management of health care: other requirements

       ``(a) In managing the provision of hospital care and 
     medical services under section 1710(a) of this title, the 
     Secretary shall, to the extent feasible, design, establish 
     and manage health care programs in such a manner as to 
     promote cost-effective delivery of health care services in 
     the most clinically appropriate setting.
       ``(b) In managing the provision of hospital care and 
     medical services under section 1710(a) of this title, the 
     Secretary--
       ``(1) may contract for hospital care and medical services 
     when Department facilities are not capable of furnishing such 
     care and services economically, and

[[Page H8769]]

       ``(2) shall make such rules and regulations regarding 
     acquisition procedures or policies as the Secretary considers 
     appropriate to provide such needed care and services.
       ``(c) In managing the provision of hospital care and 
     medical services under section 1710(a) of this title, the 
     Secretary shall ensure that the Department maintains its 
     capacity to provide for the specialized treatment and 
     rehabilitative needs of disabled veterans described in 
     section 1710(a) of this title (including veterans with spinal 
     cord dysfunction, blindness, amputations, and mental illness) 
     within distinct programs or facilities of the Department that 
     are dedicated to the specialized needs of those veterans in a 
     manner that (1) affords those veterans reasonable access to 
     care and services for those specialized needs, and (2) 
     ensures that overall capacity of the Department to provide 
     such services is not reduced below the capacity of the 
     Department, nationwide, to provide those services, as of the 
     date of the enactment of this section.
       ``(d) In managing the provision of hospital care and 
     medical services under section 1710(a) of this title, the 
     Secretary shall ensure that any veteran with a service-
     connected disability is provided all benefits under this 
     chapter for which that veteran was eligible before the date 
     of the enactment of this section.''.
       (2) The table of sections at the beginning of chapter 17 is 
     amended by inserting after the item relating to section 1704 
     the following new items:

``1705. Management of health care: patient enrollment system.
``1706. Management of health care: other requirements.''.

       (b) Conforming Amendments to Section 1703.--(1) Section 
     1703 is amended--
       (A) by striking out subsections (a) and (b); and
       (B) in subsection (c) by--
       (i) striking out ``(c)'', and
       (ii) striking out ``this section, sections'' and inserting 
     in lieu thereof ``sections 1710,''.
       (2)(A) The heading of such section is amended to read as 
     follows:

     ``Sec. 1703. Annual report on furnishing of care and services 
       by contract''.

       (B) The item relating to such section in the table of 
     sections at the beginning of chapter 17 is amended to read as 
     follows:

``1703. Annual report on furnishing of care and services by 
              contract.''.

     SEC. 5. IMPROVED EFFICIENCY IN HEALTH CARE RESOURCE 
                   MANAGEMENT.

       (a) Repeal of Sunset Provision.--Section 204 of the 
     Veterans Health Care Act of 1992 (Public Law 102-585; 106 
     Stat. 4950) is repealed.
       (b) Cost Recovery.--Title II of such Act is further amended 
     by adding at the end the following new section:

     ``SEC. 207. AUTHORITY TO BILL HEALTH-PLAN CONTRACTS.

       ``(a) Right To Recover.--In the case of a primary 
     beneficiary (as described in section 201(2)(B)) who has 
     coverage under a health-plan contract, as defined in section 
     1729(i)(1)(A) of title 38, United States Code, and who is 
     furnished care or services by a Department medical facility 
     pursuant to this title, the United States shall have the 
     right to recover or collect charges for such care or services 
     from such health-plan contract to the extent that the 
     beneficiary (or the provider of the care or services) would 
     be eligible to receive payment for such care or services from 
     such health-plan contract if the care or services had not 
     been furnished by a department or agency of the United 
     States. Any funds received from such health-plan contract 
     shall be credited to funds that have been allotted to the 
     facility that furnished the care or services.
       ``(b) Enforcement.--The right of the United States to 
     recover under such a beneficiary's health-plan contract shall 
     be enforceable in the same manner as that provided by 
     subsections (a)(3), (b), (c)(1), (d), (f), (h), and (i) of 
     section 1729 of title 38, United States Code.''.

     SEC. 6. SHARING AGREEMENTS FOR HEALTH CARE RESOURCES.

       (a) Repeal of Section 8151.--(1) Subchapter IV of chapter 
     81 is amended--
       (A) by striking out section 8151; and
       (B) by redesignating sections 8152, 8153, 8154, 8155, 8156, 
     8157, and 8158 as sections 8151, 8152, 8153, 8154, 8155, 
     8156, and 8157, respectively.
       (2) The table of sections at the beginning of such chapter 
     is amended--
       (A) by striking out the item relating to section 8151; and
       (B) by revising the items relating to sections 8152, 8153, 
     8154, 8155, 8156, 8157, and 8158 to reflect the 
     redesignations by paragraph (1)(B).
       (b) Revised Authority for Sharing Agreements.--Section 8152 
     (as redesignated by subsection (a)(1)(B)) is amended--
       (1) in subsection (a)(1)(A)--
       (A) by striking out ``specialized medical resources'' and 
     inserting in lieu thereof ``health-care resources''; and
       (B) by striking out ``other'' and all that follows through 
     ``medical schools'' and inserting in lieu thereof ``any 
     medical school, health-care provider, health-care plan, 
     insurer, or other entity or individual'';
       (2) in subsection (a)(2) by striking out ``only'' and all 
     that follows through ``are not'' and inserting in lieu 
     thereof ``if such resources are not, or would not be,'';
       (3) in subsection (b), by striking out ``reciprocal 
     reimbursement'' in the first sentence and all that follows 
     through the period at the end of that sentence and inserting 
     in lieu thereof ``payment to the Department in accordance 
     with procedures that provide appropriate flexibility to 
     negotiate payment which is in the best interest of the 
     Government.'';
       (4) in subsection (d), by striking out ``preclude such 
     payment, in accordance with--'' and all that follows through 
     ``to such facility therefor'' and inserting in lieu thereof 
     ``preclude such payment to such facility for such care or 
     services'';
       (5) by redesignating subsection (e) as subsection (f); and
       (6) by inserting after subsection (d) the following new 
     subsection (e):
       ``(e) The Secretary may make an arrangement that authorizes 
     the furnishing of services by the Secretary under this 
     section to individuals who are not veterans only if the 
     Secretary determines--
       ``(1) that such an arrangement will not result in the 
     denial of, or a delay in providing access to, care to any 
     veteran at that facility; and
       ``(2) that such an arrangement--
       ``(A) is necessary to maintain an acceptable level and 
     quality of service to veterans at that facility; or
       ``(B) will result in the improvement of services to 
     eligible veterans at that facility.''.
       (c) Cross-Reference Amendments.--(1) Section 8110(c)(3)(A) 
     is amended by striking out ``8153'' and inserting in lieu 
     thereof ``8152''.
       (2) Subsection (b) of section 8154 (as redesignated by 
     subsection (a)(1)(B)) is amended by striking out ``section 
     8154'' and inserting in lieu thereof ``section 8153''.
       (3) Section 8156 (as redesignated by subsection (a)(1)(B)) 
     is amended--
       (A) in subsection (a), by striking out ``section 8153(a)'' 
     and inserting in lieu thereof ``section 8152(a)''; and
       (B) in subsection (b)(3), by striking out ``section 8153'' 
     and inserting in lieu thereof ``section 8152''.
       (4) Subsection (a) of section 8157 (as redesignated by 
     subsection (a)(1)(B)) is amended--
       (A) in the matter preceding paragraph (1), by striking out 
     ``section 8157'' and ``section 8153(a)'' and inserting in 
     lieu thereof ``section 8156'' and ``section 8152(a)'', 
     respectively; and
       (B) in paragraph (1), by striking out ``section 
     8157(b)(4)'' and inserting in lieu thereof ``section 
     8156(b)(4)''.

     SEC. 7. PERSONNEL FURNISHING SHARED RESOURCES.

       Section 712(b)(2) is amended--
       (1) by striking out ``the sum of--'' and inserting in lieu 
     thereof ``the sum of the following:'';
       (2) by capitalizing the first letter of the first word of 
     each of subparagraphs (A) and (B);
       (3) by striking out ``; and'' at the end of subparagraph 
     (A) and inserting in lieu thereof a period; and
       (4) by adding at the end the following:
       ``(C) The number of such positions in the Department during 
     that fiscal year held by persons involved in providing 
     health-care resources under section 8111 or 8152 of this 
     title.''.

     SEC. 8. AUTHORIZATION OF APPROPRIATIONS.

       There is authorized to be appropriated for the Department 
     of Veterans Affairs for the Medical Care account, for the 
     purposes specified for that account in Public Law 103-327 
     (108 Stat. 2300), including the cost of providing hospital 
     care and medical services under the amendments made by 
     section 2, not to exceed $17,250,000,000 for fiscal year 1997 
     and not to exceed $17,900,000,000 for fiscal year 1998.

     SEC. 9. REPORT ON IMPLEMENTATION AND OPERATION.

       (a) Report Required.--In carrying out sections 2, 3, and 4 
     (including the amendments made by those sections), the 
     Secretary of Veterans Affairs shall establish information 
     systems to assess, and, not later than March 1, 1998, shall 
     submit to the Committees on Veterans' Affairs of the Senate 
     and House of Representatives, a report reflecting the 
     experience of the Department during fiscal year 1997 on--
       (1) the effect of implementation of, and provision and 
     management of care under, sections 2, 3, and 4, on demand for 
     health care services from the Department of Veterans Affairs 
     by veterans described in section 1710(a)(1), as amended by 
     section 2;
       (2) any differing patterns of demand on the part of such 
     veterans relating to such factors as relative distance from 
     Department facilities and prior experience, or lack of 
     experience, as recipients of care from the Department;
       (3) the extent to which the Department has met such demand 
     for care; and
       (4) changes in health-care delivery patterns in Department 
     facilities and the fiscal impact of such changes.
       (b) Matters To Be Included.--The report under subsection 
     (a) shall include detailed information with respect to fiscal 
     year 1997 regarding the following:
       (1) The number of veterans enrolled for care at each 
     Department medical facility and, of those veterans, the 
     number enrolled at each such facility who had not received 
     care from the Department during the preceding three fiscal 
     years.
       (2) With respect to those veterans who had not received 
     care from the Department during the three preceding fiscal 
     years, the total cost of providing care to those veterans, 
     shown in total and separately (A) by level of care, and (B) 
     by reference to whether care is

[[Page H8770]]

     furnished in Department facilities or under contract 
     arrangements.
       (3) With respect to the number of veterans described in 
     section 1710(a)(1), as amended by this Act, who applied for 
     health care from the Department during fiscal year 1997--
       (A) the number who applied for care (shown in total and 
     separately by facility);
       (B) the number who were denied enrollment (shown in total 
     and separately by facility); and
       (C) the number who were denied care which was considered to 
     be medically necessary but not of an emergency nature (shown 
     in total and separately by facility).
       (4)(A) The numbers and characteristics of, and the type and 
     extent of health care furnished to, veterans enrolled for 
     care (shown in total and separately by facility).
       (B) The numbers and characteristics of, and the type and 
     extent of health care furnished to, veterans not enrolled for 
     care (shown separately by reference to each class of 
     eligibility, both in total and separately by facility.
       (5) The specific fiscal impact (shown in total and by 
     geographic health-care delivery areas) of changes in delivery 
     patterns instituted under the amendments made by this Act.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Arizona [Mr. Stump] and the gentleman from Mississippi [Mr. Montgomery] 
each will control 20 minutes.
  The Chair recognizes the gentleman from Arizona [Mr. Stump].


                             general leave

  Mr. STUMP. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days within which to revise and extend their remarks 
and include extraneous material on this bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Arizona?
  There was no objection.
  Mr. STUMP. Mr. Speaker, I yield myself such time as I may consume.
  (Mr. STUMP asked and was given permission to revise and extend his 
remarks.)
  Mr. STUMP. Mr. Speaker, H.R. 3118, the Veterans' Health Care 
Eligibility Reform Act of 1996, is hopefully the first step toward 
overhauling the confusing eligibility requirements currently 
confronting our veterans. This bipartisan legislation will move the VA 
away from its expensive focus on inpatient care to a more accessible 
and cost effective primary and outpatient means of delivering health 
care. Eligibility reform has been the top priority of the Committee on 
Veterans' Affairs in the 104th Congress. We have worked very hard to 
make this bill as budget neutral as possible.

                              {time}  1330

  The VA committee, as well as the Department of Veterans Affairs, 
believes the bill can be implemented without the need for additional 
funds. However, the Congressional Budget Office disagrees and estimates 
that if fully funded, H.R. 3118 would result in increased demand for VA 
health care.
  Mr. Speaker, the bill is already subject to annual appropriations 
since the VA health care is a discretionary spending program. In order 
to further address CBO estimates and assure members of the Committee on 
Veterans' Affairs budget-neutral intent, we are adding provisions that 
will place a ceiling on authorized levels for VA health care for fiscal 
years 1997 and 1998.
  Mr. Speaker, I want to thank the leadership and particularly the 
gentleman from New York [Mr. Solomon], the chairman of the Committee on 
Rules, the gentleman from Ohio [Mr. Kasich], chairman of the Committee 
on the Budget, for their assistance in getting this bill to the floor 
today.
  Mr. Speaker, H.R. 3118 may be the final bill brought to the floor of 
the House by the Committee on Veterans' Affairs during the 104th 
Congress. I must take just a moment to express my deep appreciation and 
sincere thanks to my good friend, the gentleman from Mississippi, Sonny 
Montgomery, the ranking member of the full committee for his work on 
this committee and on this measure.
  Mr. Speaker, without the leadership of Sonny Montgomery on veterans 
issues over the past 30 years, this country would not have fulfilled 
its obligations to our veterans of military service the way they have. 
The commitment and dedication of Mr. Montgomery to the men and women 
serving in our armed services has rightfully earned him the title ``Mr. 
Veteran''.
  The members of the Committee on National Security and the Committee 
on Veterans' Affairs will miss him energetic support for those 
individuals wearing our country's uniforms and for those who have worn 
it. I will personally miss his friendship and counsel over the many 
years that we have served together in this body. We wish this great 
legislator well in all his future endeavors.
  Mr. Speaker, I reserve the balance of my time.
  Mr. MONTGOMERY. Mr. Speaker, I yield myself such time as I may 
consume.
  I certainly want to thank my chairman, the gentleman from Arizona, 
Bob Stump, for those very kind and warm words. We have had a wonderful 
working relationship and great friendship. To Bob Stump and to the 
whole committee, we have been nonpartisan, and we are very proud of 
that, Mr. Speaker. Our bottom line is to help the veterans, and Bob 
Stump has been right there with us all the way, and I thank him again 
for those very, very kind remarks, and I hope that they will remember 
us some 4 or 5 years from now when we are out somewhere else.
  Mr. Speaker, representatives of the major national veterans 
organizations have told us that their top legislative priority is 
enactment of legislation to reform the VA health care eligibility 
rules. Working on a bipartisan basis, we have put a lot of effort into 
this, Mr. Speaker, and I congratulate, again, the chairman, Mr. Stump, 
on bringing an excellent bill to the floor, H.R. 3138. It has been 
endorsed by virtually all the major veterans organizations.
  We know that the reforms the veterans' groups had proposed would go 
further than we do today, but they do agree that this bill is a big 
step forward.
  I wish, Mr. Speaker, we could do more, but some other committees of 
the House could object and we need to get what we can on eligibility 
out for the veterans.
  My good friend and our chairman, Bob Stump, as well as the gentleman 
from Arkansas, Tim Hutchinson, the chairman of the Subcommittee on 
Hospitals and Health Care, and the gentleman from Texas, Chet Edwards, 
the subcommittee's ranking member, have really put a lot of time into 
developing this important bill and ensuring that it met the concerns of 
the veterans.
  Our committee's work on eligibility reform actually started before 
the 104th Congress, and I particularly want to acknowledge the 
outstanding oversight work on this subject done by my very able 
colleague, the gentleman from Illinois, Lane Evans, who chaired our 
former Subcommittee on Oversight and Investigations.
  Mr. Speaker, this bill would reform outdated eligibility laws that 
would make it easier to go to outpatient clinics and take care of these 
veterans at less cost and more veterans would be eligible to use our 
medical facilities. It would simplify rules which are so complex that 
even the VA doctors are often confused over who is eligible for what. 
It would give VA for the first time clear authority to plan for and 
provide treatment to veterans based simply on meeting their medical 
needs.
  This legislation, Mr. Speaker, also has the support of the Department 
of Veterans Affairs, which recognizes the need for change and has urged 
us to give them the authority to improve the way they do business. I 
think this bill would give VA important tools to provide the kind of 
care we owe our veterans and to do it in an efficient and effective 
manner.
  Mr. Speaker, In adopting eligibility reform legislation, we are 
remedying longstanding problems and addressing a long-sought need for 
change. In pursuing eligibility reform as a goal, however, some have 
had very lofty expectations of what such reform would achieve. Such 
high expectations have led some advocates to blur the distinction 
between eligibility reform and funding reform. H.R. 3118 does not 
attempt to change the manner in which VA medical care is funded. In 
contrast, committee amendments to H.R. 3600, 103d Congress, the 
President's national health care reform bill, would have converted 
funding for VA health care from discretionary to mandatory funding. 
H.R. 3118's more modest target does not reflect, on this Member's part, 
a belief that those broader objectives should be abandoned.
  H.R. 3118 has, however, sparked isolated criticism, largely related 
to what it does not attempt to do. Those criticism warrant 
acknowledgment.
  The most common criticism of this legislation has focused on language 
which, in

[[Page H8771]]

amending section 1710(a) of title 38, U.S. Code, qualifies the VA's 
obligation to provide hospital care and medical services, stating that 
VA shall provide care ``to the extent and in the amount provided in 
advance in appropriations Acts for these purposes.'' In essence this 
language limits VA medical care spending under the bill to the 
availability of appropriations. VA health care, however, is currently 
subject to appropriations; this language does not change that fact.
  H.R. 3118 aims to improve statutory eligibility rules which have been 
attacked for years as badly in need of reform. Under those rules, for 
example, most nonservice-connected veterans are not even eligible for 
routine outpatient treatment and generally are eligible for home health 
care or prosthetics only if they have been hospitalized. This bill 
would remedy these and other barriers to VA's providing medically 
needed care. The bill's supporters including most veterans 
organizations, have described H.R. 3118 as an important step forward, 
but the bill has never been represented as a solution to all the 
challenges facing VA. For those of us who believe that the wisest 
legislative strategy is to make as much progress as you can, when you 
can, achieving substantial, positive reform of VA health care 
eligibility laws is a good first step.
  With respect to funding, the bill has been attacked on the basis that 
if funding levels are not sufficient, veterans will be denied care. 
Unfortunately, inadequate funding levels would have that same effect 
whether or not H.R. 3118 were enacted, just as they have had in the 
past.
  One critic has expressed concerns that veterans would lose access to 
VA care by virtue of a provision of the bill requiring establishment 
and implementation of an enrollment system. In fact, the bill does not 
specify how that system must work, but allows VA to design a workable 
system. That system should enhance VA's ability to plan for and 
effectively serve patients, while providing sufficient flexibility so 
as not to disenfranchise its most vulnerable and needy veterans. The 
report on the bill clarifies that the provision is flexible and would 
allow VA ``to establish an enrollment system which simply registers 
patients throughout all or part of a fiscal year.'' In fact, the aim of 
this legislation is to improve veterans' access to VA care. Its 
drafting reflects an understanding that VA is very much a safety net, 
serving, for example, a substantial population of veterans with serious 
mental illness. The bill does not envision that such veterans can 
necessarily be expected to respond to requests to enroll for care 
within a time-limited registration period; the drafting of the bill 
assumes that an enrollment system would be designed, whether through 
provision for exceptions or otherwise, with such patients in mind.

  Finally, the bill has also sparked criticism based on a view that the 
priorities for enrollment reflected in the legislation are inequitable 
and unacceptable because 10 and 20 percent service-connected veterans 
are not included in the highest priority classification. This view 
fails to take account of the fact that under existing law--38 U.S.C. 
section 1712(i)--less than 30 percent service-connected veterans have 
been second in line for care since 1988, when Congress moved them up 
from third in line in a statutory treatment priority system, where they 
had been since 1976.
  Overall, the voices of criticism have been very few, and have been 
overwhelmingly drowned out by those in support. It is important, 
nevertheless, to set the record straight. In short, Mr. Speaker, this 
is an excellent bill.
  Mr. Speaker, I include for the Record a letter dated July 26, 1996, 
from an organization entitled the Independent Budget.

                                       The Independent Budget,

                                    Washington, DC, July 26, 1996.
     Hon. G.V. Montgomery,
     House of Representatives, Rayburn House Office Bldg., 
         Washington, DC.
       Dear Representative Montgomery: We are writing to request 
     your strong support for H.R. 3118, ``The Veterans' Health 
     Care Eligibility Reform Act of 1996.'' The bill is scheduled 
     to be brought to the House Floor on Tuesday, July 30, 1996.
       Our organizations represent the authors and endorsers of 
     ``The Independent Budget'', an annual review of budget and 
     policy matters affecting the benefits and services of the 
     Department of Veterans Affairs. Reforming the VA health care 
     system's arcane and inefficient eligibility rules has been a 
     top priority of our organizations for many years.
       Current VA eligibility rules dictate what type of services 
     a veteran will receive based on an overly complex system of 
     categorical classifications, such as degree of disability, 
     income, or type of veteran service or status. These 
     eligibility rules give little regard to what would be the 
     best, the most cost effective or the most appropriate venue 
     required to provide the full range of health services a 
     veteran needs. Such disjointed services are both inconvenient 
     and unwarrantedly expensive.
       The reforms provided for in H.R. 3118, would, for the first 
     time, give VA health care providers the ability to provide 
     the full range of appropriate health care services to 
     eligible veterans utilizing the most cost effective and 
     efficient methods of modern medical practice.
       We consider passage of H.R. 3118 to be one of our highest 
     priorities for the 104th Congress.
       Thank you for your consideration.
           Sincerely,
         Kenneth E. Wofford, National Commander, AMVETS; Thomas A. 
           McMasters III, National Commander, Disabled American 
           Veterans; Carroll M. Fyffe, National Commander, 
           Military Order of the Purple Heart; Richard Grant, 
           National President, Paralyzed Veterans of America; 
           James L. Brazee, Jr., National President, Vietnam 
           Veterans of America, Inc.; Richard G. Fazakerley, Maj. 
           Gen. (Ret.), National President, Blinded Veterans 
           Association; Neil Goldman, National Commander, Jewish 
           War Veterans of the USA; Charles R. Jackson, President, 
           Non Commissioned Officers Association; Paul A. Spera, 
           Commander-in-Chief, Veterans of Foreign Wars of the 
           United States.

  Mr. Speaker, I reserve the balance of my time.
  Mr. STUMP. Mr. Speaker, I yield myself such time as I may consume to 
also thank the gentleman from Arkansas, Tim Hutchinson, Chairman of the 
Subcommittee on Hospitals and Health Care, and the gentleman from 
Texas, Chet Edwards, the ranking member on that subcommittee, for all 
their hard work not only on this bill, but for both their cooperation 
and hard work for carrying the major loads for this committee for this 
year.
  Mr. Speaker, I yield such time as he may consume to the gentleman 
from Arkansas [Mr. Hutchinson].
  Mr. HUTCHINSON. Mr. Speaker, I thank the chairman for yielding me 
this time, and I want to join the chairman in expressing, once again, 
to the gentleman from Mississippi, Sonny Montgomery, how much he will 
be missed in this Chamber and in this House. This is the last bill that 
the committee will bring to the floor this year and it is an 
appropriate time.
  My predecessor, John Paul Hammerschmidt, regarded no one higher and 
no one closer to him during his 26 years of service in the House than 
his relationship with Sonny Montgomery. He would come back to Arkansas 
many times and lauding the achievements of Chairman Montgomery and his 
advocacy on behalf of veterans. All I can say today is, the half was 
not told.
  I have enjoyed the last 4 years getting to know the gentleman and I 
wish to tell him he certainly will be missed.
  Mr. Speaker, today is indeed a historic day for America's veterans, 
for it marks the end of a 10-year quest to streamline eligibility for 
veterans' health care. Under the leadership of Chairman Bob Stump and 
in the true spirit of bipartisanship demonstrated by the ranking 
members of the full committee and subcommittee, Sonny Montgomery and 
Chet Edwards, the Veterans' Affairs Committee has taken the first major 
step to move the delivery of veterans' health care into the 21st 
century.
  The Veterans' Health Care Eligibility Reform Act of 1996, while not 
the panacea for all the ills of VA health care, is the first step in 
the rational transformation of the arcane eligibility provisions which 
have literally crippled the delivery of VA health services and have 
left patients feeling cheated and confused. The bill substitutes a 
single, streamlined eligibility provision--based on clinical need for 
care--for the complex array of disparate rules currently governing 
eligibility for hospital and outpatient care. In doing so, it would 
lift restrictions on VA's providing ambulatory treatment. Those 
restrictions currently tie many veterans' eligibility for outpatient 
treatment to determinations that are medically uninterpretable such as 
``to obviate the need for hospital admission.'' The application of 
these medically indefinable standards have contributed to relative 
disparities in different areas of the country as veterans attempted to 
access VA health care.
  Understanding that this bill is the first of many steps to come in 
improving veterans' health care, it also contains a number of other 
important provisions. The bill eliminates restrictions on prosthetic 
devices but does not turn VA into a drugstore for such devices as 
hearing aids and eyeglasses. It requires VA to manage the provision of 
hospital care and medical services through an enrollment system 
according to a series of priorities. The bill refocuses our

[[Page H8772]]

time-honored commitment to service-connected care while allowing the VA 
to manage care for those veterans with lesser means who depend upon the 
VA as their health care safety net.
  Other important provisions expand operational flexibility by enabling 
the VA to contract for hospital care and medical services to increase 
the cost-effective provision of care and services. The bill expands 
VA's authority to execute sharing agreements by permitting any medical 
resource to be provided under a contractual agreement with any entity. 
It also authorizes flexibility in the establishment of payment levels 
and exempts the personnel involved in providing services under such 
arrangements from personnel hiring limits. This exemption should be 
very helpful as VA seeks to participate to a greater extent with 
TRICARE and other managed care programs.
  An important consideration of this bill is that it offers protection 
of specialized services by directing the VA to maintain its capacity to 
provide for the specialized treatment and rehabilitation of disabled 
veterans within distinct programs and facilities dedicated to the 
specialized needs of veterans.
  In closing I would like to address the controversial cost estimate 
placed on this bill by the Congressional Budget Office, an estimate 
that we have strongly refuted with a committee cost estimate. To 
further ensure budget neutrality of the bill, it has been amended to 
include not only subject to appropriations language but a 2-year cap on 
the authorization for the medical care appropriation.
  Eligibility reform, in my view, is as significant a piece of 
legislation as the G.I. bill. I urge my colleagues to show their 
support of veterans by supporting H.R. 3118, the Veterans' Health Care 
Eligibility Reform Act of 1996.
  Mr. MONTGOMERY. Mr. Speaker, I yield myself such time as I may 
consume to thank the gentleman from Arkansas, Tim Hutchinson, for his 
very, very kind remarks. We have certainly enjoyed having him in the 4 
years he has been on our committee. I would ask him to please tell John 
Paul Hammerschmidt I said hello.
  Mr. Speaker, I yield such time as he may consume to the distinguished 
gentleman from Texas, Mr. Chet Edwards.
  Mr. EDWARDS. Mr. Speaker, because of our Nation's veterans, America 
won the cold war; because of our Nation's veterans, today we are the 
superpower in the world; and because of them our children today live in 
a safer world. This bill, H.R. 3118, is an effort, a simple but 
important one, to say thank you to those men and women who have served 
our Nation in uniform and now need service in our Nation's Va 
hospitals.
  This bill is a win-win. It is a win for veterans who will receive 
better care because of this legislation, and it is a win for our 
Nation's taxpayers because it will see that their limited resources are 
used more efficiently and effectively on behalf of our Nation's 
veterans.
  Basically, this bill does two things. It simplifies rules for VA 
health care, eligibility rules that perhaps are as complicated as the 
IRS Tax Code. By simplifying them, we will have a fairer and better 
system for our veterans. Second, it will facilitate effective and 
efficient outpatient care for our Nation's veterans.
  Mr. Speaker, the Committee on Veterans' Affairs has worked for years 
to enact legislation that would achieve a comprehensive reform of VA 
health care laws. H.R. 3118 is not the final answer, but it is a very 
important first step. It does not remedy the serious funding challenges 
that the VA has faced. It does not guarantee that every veteran will 
get the care that they seek.
  Comprehensive answers are beyond what we can accomplish in the few 
remaining days of this session. Nevertheless, this legislation is a 
bipartisan major step in the positive direction of serving our 
veterans.
  It is important legislation. This bill dismantles the statutory 
barriers that have interfered with VA efforts to deliver appropriate 
care. It simplifies an overly complex set of eligibility rules. It 
expands veterans' access to routine outpatient care, to preventive 
services and needed prosthetic supplies. And by providing greater 
latitude for contracting, it gives the VA important new tools to manage 
care delivery more effectively.
  While this bill will help the VA to streamline its health care 
delivery, it does provide very needed protection for some of the VA's 
most unique and potentially vulnerable programs. At a time that the VA 
must make every effort to reduce duplication and unnecessary 
expenditures, veterans have urged us to be especially vigilant to 
ensure that the VA maintains its vital specialized treatment and 
rehabilitation programs.
  The bill gives specific recognition to these programs and would 
provide safeguards to ensure that the VA retains the capacity to serve 
the specialized needs of the spinal cord injured, the blind, the 
mentally ill, and other disabled veterans dependent on the VA's 
specialized care programs.
  Our efforts in this bill to help the VA expand veterans' access to 
primary care services does not signal an intent to abandon needed 
though sometimes costly specialized treatment missions.
  Finally, Mr. Speaker, I want to add to the comments of other 
colleagues on this floor. I want to add my deep and lasting gratitude 
to the gentleman from Mississippi [Mr. Montgomery] for his many, many 
years of service to his country, both in uniform and here as a Member 
of Congress.
  To the gentleman from Arizona, Mr. Stump, the partner with Mr. 
Montgomery for so many years now in fighting for our Nation's veterans, 
this legislation would not be on this floor without his leadership as 
chairman of the committee.

                              {time}  1345

  To the gentleman from Arkansas [Mr. Hutchinson], the subcommittee 
chair who worked tirelessly with veterans service organizations and 
Members of this House on both sides of the aisle to help bring this 
bill to the floor, and finally and not least importantly I want to say 
thanks to the gentleman from New York [Mr. Solomon], the chairman of 
the Committee on Rules who helped see that this bill could come to the 
floor in a timely fashion, knowing that there is not much time left in 
this session of Congress and if we are to turn this from a bill into 
law we must move quickly. So my thanks go out to Chairman Solomon for 
his bringing this together.
  Mr. Speaker, as with so much of the legislation for our Nation's 
veterans heralded and pushed through this House by the gentleman from 
Mississippi [Mr. Montgomery] and the gentleman from Arizona [Mr. 
Stump], there is not a big fight on this floor today. There is not a 
lot of people in the press gallery. Perhaps some think unless there is 
a fight, it is not important legislation. But, Mr. Speaker, I would 
suggest this is some of the most important legislation we have passed 
on behalf of veterans for a long, long time, and it is a credit to the 
leaders that I have mentioned in my last few comments that this is 
coming to the floor on a bipartisan basis.
  What a shame it is that the country does not see the headlines, the 
articles, the news coverage when there is such a cooperative effort 
made in this House of Representatives. But more important than the news 
coverage is the fact that this legislation when passed into law will 
make life better for our Nation's veterans who served all of us.
  Mr. STUMP. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I thank the gentleman from Texas [Mr. Edwards] once 
again for all of his work and for his very kind remarks on the floor 
just now.
  Mr. COLEMAN. Mr. Speaker, will the gentleman yield?
  Mr. STUMP. I yield to the gentleman from Texas.
  Mr. COLEMAN. Mr. Speaker, I only wanted to associate myself with the 
remarks of my colleague from Texas. I think all of us, particularly 
from that region of the country, as well as the gentleman from Arizona, 
understand the importance of the statements made by my colleague from 
Waco, TX, and I wanted to associate myself with his remarks, and I 
thank the gentleman for yielding.
  Mr. STUMP. Mr. Speaker, I yield 3 minutes to the distinguished 
gentleman from New York [Mr. Solomon], chairman of the Committee on 
Rules.
  Mr. SOLOMON. Mr. Speaker, I cannot tell you how proud I am to stand 
up here today as one of the sponsors of this critical veterans 
legislation. I

[[Page H8773]]

commend the gentleman from Arizona [Mr. Stump], the gentleman from 
Mississippi [Mr. Montgomery], the gentleman from Arkansas [Mr. 
Hutchinson], and the gentleman from Texas [Mr. Edwards], and the entire 
Committee on Veterans' Affairs for their hard work in bringing this 
legislation to the floor.
  Mr. Speaker, I served on that committee for 10 years. It was such a 
pleasure because it was a committee of comity. Everybody worked 
together for one common goal, and I commend my colleagues for it.
  Mr. Speaker, VA eligibility reform has been a long, long time in the 
making, and that is why it is such a relief for the veterans community 
that we take this step here today. Ever since my days back in the 
Committee on Veterans' Affairs and as a ranking member of that body, 
alongside my good friend, the gentleman from Mississippi [Mr. 
Montgomery], and the gentleman from Arizona [Mr. Stump], eligibility 
reform has been one of our top priorities.
  The reform bill we pass here today is a positive step in preserving 
the future of the VA and veterans' health care. No matter how you look 
at it Mr. Speaker, the fact remains that the veterans population is 
dwindling. That means that it is up to us here today, those of us who 
understand why it is absolutely critical that we protect the earned 
contractual benefits of all of our veterans, to pass these protections 
and to pass them into law.

  H.R. 3118 I think is a great step toward streamlining health care 
delivery within the veterans department. It will provide the basis for 
constructing a system that will preserve the future of VA health care 
and continue the all-important guarantee of health care for America's 
deserving veterans, and that is something we have to guarantee down the 
road for our all-voluntary military.
  Mr. Speaker, I urge my fellow veterans and all Members of Congress to 
pass this bill and finally put the process of reforming VA health care 
underway. Americas veterans will thank you.
  Mr. Speaker, in closing, let me heap praise on the former chairman of 
this committee, Sonny Montgomery. As a veteran myself, I know I speak 
for all of the veterans throughout this entire Nation in saying that we 
are grateful for everything that the gentleman from Mississippi has 
done all of these years. He is a great Congressman. He is a great 
American and, more than that, he is a great friend of mine, and I wish 
him the best in his retirement.
  Mr. MONTGOMERY. Mr. Speaker, I yield myself 30 seconds.
  Mr. Speaker, I apologize to the gentleman from New York for not 
getting all of those remarks, but thank him very much. I want to point 
out to my colleagues here today that the gentleman from New York, Mr. 
Solomon, and I did work with him, but he was the leader that got the 
Department of Veterans Affairs to be implemented and to become law, and 
I would like to say on account of Jerry and others that the veterans 
can go in the front door of the White House now where we used to have 
to go in the back door. In fact, we had an administrator of the 
veterans department that has to go through an individual in the White 
House to see what needed to be done for veterans. And now we have the 
Department of Veterans Affairs and Jesse Brown, who is a strong 
Secretary and going a good job in my opinion.
  I thank Chet Edwards for what he said about us.
  Mr. Speaker, I yield 2 minutes to the gentleman from California [Mr. 
Filner].
  Mr. FILNER. Mr. Speaker, I thank the gentleman for yielding.
  Mr. Speaker, H.R. 3118, The Veterans' Health Care Eligibility Reform 
Act of 1966, is an important step toward improving health care for our 
Nation's veterans.
  The veterans in my congressional district, the leaders of San Diego 
County's veterans community, and the representatives of national 
veterans organizations all agree that we need veterans' health care 
eligibility reform.
  This bill will simplify the rules governing VA medical care. It will 
allow veterans to get outpatient service when that is more appropriate 
than inpatient care. This bill will allow the VA to treat veterans for 
less money, with the savings going for expanded services.
  Veterans' health care eligibility reform is one of the first issues 
confronting me when I came to Congress in 1993, and I am proud to be a 
member of the Veterans Affairs Committee which has worked so hard on 
this bill.
  I appreciate the work of Chairman Bob Stump, ranking member Sonny 
Montgomery, chairman of the Subcommittee on Hospitals and Health Care 
Tim Hutchinson, and Subcommittee ranking member Chet Edwards for their 
tireless efforts in developing H.R. 3118.
  As you know, similar legislation passed the Senate Veterans' Affairs 
panel last week, which makes our vote today even more important. I urge 
my colleagues to join me in support of this bill.
  If this is indeed the last bill that Sonny Montgomery will be on the 
floor for, we also want to add our profuse gratitude for his 
friendship. I knew Sonny before any of you did, by the way. I worked 
with him before he was a Member of Congress, when he was a general in 
Mississippi. He taught us everything, and I think that the lasting, the 
greatest legacy that Sonny Montgomery will have is that as much work as 
he did, there is still more work to be done for veterans, and he has 
trained us all, educated us all, and we will carry on the work that he 
has been so successful at and we will finish the job that he started.
  Mr. STUMP. Mr. Speaker, I yield 2 minutes to the gentleman from 
Illinois [Mr. Weller], a member of the committee.
  (Mr. WELLER asked and was given permission to revise and extend his 
remarks.)
  Mr. WELLER. Mr. Speaker, I come to the well today to speak on behalf 
of this bipartisan bill, which will enable tens of thousands of rural 
veterans to have greater access to VA outpatient health care. H.R. 3118 
provides much-needed authority and allows the VA for the first time 
ever to enter into sharing agreements with local health care providers 
so that rural and suburban veterans can benefit from the convenience of 
utilizing health care services in their local community, to be treated 
by local doctors and local hospitals they know and trust.
  For example, in my home district in LaSalle County, IL, the closest 
outpatient center for veterans is 60 miles away. We have 45,000 
veterans in the LaSalle County area. Sixty miles is a long way to 
travel, and for many veterans it requires that they ask friends and 
family to take off half a day or a full day just to provide 
transportation.
  This past spring, the gentleman from Arkansas [Mr. Hutchinson] and 
the Subcommittee on Hospitals and Health Care held a field hearing in 
LaSalle County and brought to light the need for some changes in VA 
authority to be brought forward. Thanks to this hearing, we noted that 
the VA is currently prohibited from contracting with private, nonprofit 
health care providers.
  This legislation, when passed into law, will not only benefit 
counties like LaSalle in Illinois, but other rural care areas 
throughout the Nation. This language was originally in H.R. 3321, a 
bill I introduced to allow the VA to enter into contractual agreements 
with local health care providers, doctors and hospitals in order to 
provide health care to veterans locally.
  Mr. Speaker, it just makes common sense to make it easier and more 
convenient for veterans to have the opportunity to obtain veterans 
health care right in their local community, right from their local 
doctors, right from their local hospitals they know and trust.
  I want to note that this legislation has broad-based support in the 
veterans community; has broad-based bipartisan support amongst local 
officials and members of this committee. I am proud that we are keeping 
our commitment to our veterans and doing it in a bipartisan fashion. 
Let us move forward and provide quality health care for our veterans 
and meet our commitment to our veterans and give this bill bipartisan 
support.
  Mr. Speaker, I commend the chairman of the committee, the gentleman 
from Arizona [Mr. Stump], and the ranking member for their efforts and 
their bipartisan leadership.
  Mr. MONTGOMERY. Mr. Speaker, I yield 2 minutes to the gentleman from

[[Page H8774]]

Massachusetts [Mr. Kennedy], who is also a member of the committee, one 
of our ranking members.
  Mr. KENNEDY of Massachusetts. Mr. Speaker, with everything I have to 
say about the gentleman from Mississippi [Mr. Montgomery], maybe he 
will want to make it 4 minutes. But let me just say very sincerely, 
from really the bottom of my heart, how much I have appreciated all of 
the hard work that Sonny Montgomery has shown.
  I think particularly for some of the younger Members of Congress that 
care very deeply about veterans issues there is no one that has stood 
up more clearly and strongly on behalf of our Nation's veterans, no one 
who commands the respect of Members of both sides of the aisle about 
the issues of concern to our Nation's veterans than Sonny Montgomery, 
and I know that Chairman Stump feels the same way.
  We have all enjoyed, although not every moment that Chairman Stump 
has had the gavel over the course of the last couple of years, I do not 
think he has enjoyed a couple of moments that I have been speaking in 
the last couple of years, but I do appreciate his sincere efforts on 
behalf of Sonny Montgomery and to bring to the former chairman of the 
committee, Mr. Montgomery, the credit that he deserves for the hard 
work that he has done on behalf of our Nation's veterans.
  Mr. Speaker, despite the fact that every other speaker has talked 
about the fact that this is Sonny's last bill on the House floor, 
unless he has some announcement, I hope he is going to be sticking with 
us through next November. And I know that his spirit will continue to 
guide us on veterans affairs far into the future.
  Mr. Speaker, I join with Chairman Stump in thanking Sonny Montgomery 
for all of the guidance, support, and courage that he has shown for our 
country and for our Nation's veterans. I really appreciate it. In 
addition, I also support this bill.
  Mr. STUMP. Mr. Speaker, I yield 1 minute to the gentleman from 
Illinois [Mr. Flanagan].
  Mr. FLANAGAN. Mr. Speaker, I rise today in full support of H.R. 3118, 
the veterans' eligibility reform bill, introduced by the gentleman from 
Arizona [Mr. Stump] and the gentleman from Mississippi [Mr. 
Montgomery].
  And, parenthetically, Mr. Speaker, I have enjoyed every moment that 
the gentleman from Arizona has had the gavel in his hand. And, Mr. 
Speaker, I would say to Mr. Montgomery, our many great thanks, our many 
great remarks at his leadership and the warmth that he has shown us 
all, freshman Member and senior Member alike, over the years.
   Mr. Speaker, I believe that this legislation, though not a complete 
reform of current eligibility standards, is a positive first step 
toward achieving that goal.
  Veterans with service-connected disabilities, former POW's and World 
War I veterans are eligible under this legislation.
  H.R. 3118 will enable the VA to provide all needed hospital and 
medical services to eligible veterans and expand operational 
flexibility by enabling VA to contract for hospital care and medical 
services to increase cost-effectiveness. It will also protect 
specialized programs, and work to expedite VA's transition from 
inpatient care to greater use of outpatient care efficiently and 
effectively. This bill will accomplish these provisions without 
reducing benefits to other veterans.
   Mr. Speaker, we must never forget the sacrifices America's veterans 
have made for our country and our freedoms. Quality and accessibility 
of veterans' health care is a priority of this Congress. H.R. 3118 
ensures that our veterans receive the very best in health care, and 
reaffirms our commitment to our veterans. I am very proud to be a 
cosponsor of H.R. 3118, as it will pave the way for greater reforms in 
the future.
  Mr. STUMP. Mr. Speaker, I yield 2 minutes to the gentleman from 
Indiana [Mr. Buyer], chairman of the Subcommittee on Education, 
Training and Employment.
  Mr. BUYER. Mr. Speaker, I thank the gentleman from Arizona [Mr. 
Stump], chairman of the Veterans' Affairs Committee, and the gentleman 
from Mississippi, [Mr. Montgomery], our good friend, for their work on 
this bill.
  Mr. Speaker, this bill represents the culmination of years of hard 
work on behalf of the most pressing issues facing the Department of 
Veterans Affairs, that being eligibility reform. Anyone who has been to 
a VA hospital knows how difficult it can be to access the VA health 
care system. The patchwork of confusing and complex rules governing 
accessibility often defy medical common sense.

                              {time}  1400

  Madam Speaker, H.R. 3118 goes a long way to change this system while 
staying within the current budget constraints. This bill requires the 
VA to manage its medical services through a system of priorities, 
giving service-connected veterans the top priority. We have some very 
difficult issues that face us, that being the veterans' community, and 
I want to thank Chairman Stump and Sonny Montgomery.
  As we have a declining veteran population out there, with a 
stabilizing VA medical system, this is a transition-type bill. I cannot 
predict what the VA system is going to look like in year 2010 to 2015, 
as we begin facing the reality of losing the World War II and Korean 
veterans, which includes my father, but how we visualize that system 
into the future is going to require some real leadership. This is a 
transition bill. It is far from a perfect bill, but I am very pleased 
with the hard work that the chairman has done. Appreciate it.
  Mr. MONTGOMERY. Madam Speaker, I yield 1 minute to the gentleman from 
North Carolina [Mr. Hefner].
  Mr. HEFNER. Madam Speaker, first of all, I would like to say we are 
certainly going to miss Sonny Montgomery around here. I served with him 
for a lot of years, worked on a lot of veterans' legislation. He is to 
be commended and he will be remembered a long, long time. As long as 
veterans are around, he will be remembered.
  Bob Stump, my dear friend from Arizona, who has worked very hard on 
this bill and labored in the vineyard for so many years. I rise in very 
strong support of this legislation and wish for Mr. Montgomery, as a 
friend of mine in North Carolina often said, I hope you live as long as 
you want and never want as long as you live, and rise in strong support 
of this legislation which is long overdue.
  I thank the gentleman from Arizona and the gentleman from Mississippi 
for bringing it to fruition.
  Mr. STUMP. Madam Speaker, I yield 2 minutes to the gentleman from 
Oregon [Mr. Cooley].
  Mr. COOLEY. Madam Speaker, I rise today in support of H.R. 3118, the 
Veterans' Health Care Eligibility Reform Act of 1996.
  I represent eastern Oregon, the seventh largest congressional 
district in the country. Veterans in my district often must drive 4 or 
5 hours--over the Cascades to Portland--in order to receive medical 
care. Veterans who must drive so far for medical service have a strong 
interest in fair and efficient eligibility standards.
  By allowing the VA to contract out for hospital care and medical 
services, and, by allowing the VA to share health care resources with 
group providers, H.R. 3118 will potentially bring the VA closer to the 
veterans of eastern Oregon.
  H.R. 3118 also abolishes the complex provisions of law governing 
eligibility for outpatient care, expanding the array of services that 
the VA can provide to our Nation's veterans.
  I urge all of my colleagues to support this long-overdue reform.
  Madam Speaker, I, too, would like to thank the leadership, Sonny 
Montgomery and his past services to the veterans of this country and, 
especially now, the reins have been passed over to Bob Stump, and what 
a fantastic job he has done to bring forth these issues which I think 
are very, very critical, especially to our veterans more in the rural 
areas that really truly have to drive many, many miles to receive this 
kind of service.
  I will tell my colleagues that in the near future I will probably be 
using these as well. I would certainly like to be able to use the local 
hospital instead of driving 155 miles to the closest veterans' hospital 
for my community where I live in Alfalfa, OR. I think that the veterans 
of the country and Congress should commend Bob Stump with the 
cooperation of Sonny Montgomery

[[Page H8775]]

and the fantastic job they have done for veterans in this country. I 
think we all are proud of both of these gentlemen.
  Mr. STUMP. Madam Speaker, I yield 1 minute to the gentleman from 
Florida [Mr. Weldon], a Member who has been very active in veterans' 
affairs for his State.
  (Mr. WELDON of Florida, asked and was given permission to revise and 
extend his remarks.)
  Mr. WELDON of Florida. Madam Speaker, I rise in strong support of the 
bill before us.
  As a veteran and a practicing physician, I understand firsthand the 
needs of veterans in underserved areas. The veterans in east-central 
Florida have suffered for over a decade and a half for lack of adequate 
veterans medical facilities. Last year this Congress set us on a sound 
road toward meeting these needs by providing $25 million to meet the 
outpatient needs of these veterans.
  H.R. 3118 includes provisions that will allow the VA to contract with 
local hospitals to meet the inpatient needs of veterans who have 
sacrificed for our great Nation.
  Last year, I introduced legislation that would allow the VA to 
contract in this manner. The bill before us includes similar provisions 
and I appreciate the chairman for his support of this concept.
  This bill will allow veterans in underserved areas, like east-central 
Florida to receive VA medical care right in their own communities. This 
is what veterans in my district have been telling me they want and I'm 
pleased to see it before us.
  Let's pass this bill.
  Madam Speaker, I rise in strong support for H.R. 3118, the Veterans 
Health Care Eligibility Reform Act. This bill is long overdue and it 
will ensure that we fulfill our commitments to our veterans.
  I would like to focus on one particular element of this bill that is 
very important to the veterans in my district. It was more than 14 
years ago that a veterans hospital was first proposed for east-central 
Florida. Since that time, more politics has been played over this 
hospital than one can recount. While politicians have enjoyed their 
sport, the veterans in Brevard and surrounding counties have suffered 
for lack of adequate veterans medical facilities.
  Earlier this year the Congress took the right step by providing $25 
million for an outpatient clinic. The VA has informed me that this 
outpatient clinic will meet at least 80 percent of the health care 
needs of area veterans. This is a good first step in meeting these 
veteran's needs. I was also pleased that in a letter to me dated July 
17, the Secretary of Veterans Affairs committed to issuing a contract 
for design work by September 1996.
  The verdict on a hospital for Brevard County is still out. There are 
some who have suggested holding up the construction of a veterans 
outpatient clinic and instead holding out for a full hospital. Anyone 
remotely familiar with the history of the Brevard medical facility 
recognizes that this would be playing Russian roulette with the lives 
of veterans and would likely see the possibility of even an outpatient 
clinic slip away.
  Earlier this year the veterans of east-central Florida received an 
authorization for a $25 million outpatient clinic, and Congress and the 
President already set aside the $25 million needed to fully construct 
this clinic. While an outpatient clinic may not meet 100 percent of the 
needs, it will meet 80 percent of the needs and it will do so in less 
than 2 years. Any delay in moving forward with this clinic may see this 
money and clinic disappear like the hopes that these veterans have seen 
fade away so many times before.
  As a physician who has been put in the unfortunate position of having 
to refer veterans across the State to a veterans hospital, I understand 
how critical it is that veterans have access to inpatient care in our 
own community. That is why I introduced H.R. 2798, the Veterans Health 
Care Management and Contracting Flexibility Act of 1995. This bill will 
allow the VA to enter into contracts with local hospitals to meet the 
inpatient health care needs of area veterans. In other words, while the 
verdict is still out on Brevard's VA hospital, veterans will be able to 
receive inpatient care at local hospitals rather than being shipped 
hours away from home and family. This in no way rules out the 
possibility of a VA hospital in the future, but it ensures that 
regardless of what happens, veterans will not continue to suffer for 
lack of adequate facilities.
  I am pleased that the provisions of my bill have been incorporated 
into H.R. 3118. Quite frankly, broad contracting authority should have 
been permitted years ago. It was wrong to allow veterans to suffer 
while politicians played. The outpatient clinic and the inpatient 
contracting will ensure that veterans in east-central Florida have 
access to health care facilities. I will continue to work with veterans 
throughout our community to ensure that their health care needs are 
met.
  I am pleased to be a part of our constructive effort to ensure that 
we follow through on our promises to those who have given of themselves 
to protect our liberty.
  Mr. STUMP. Madam Speaker, I yield 1 minute to the gentleman from 
Pennsylvania [Mr. Fox], a member of the committee.
  Mr. FOX of Pennsylvania. Madam Speaker, I rise in strong support of 
H.R. 3118, the Veterans' Health Care Eligibility Reform Act of 1996.
  I would like to commend Chairman Stump, Ranking Member Montgomery, 
Chairman Hutchinson, and Ranking Member Edwards for their joint 
leadership on this important issue of health care eligibility reform. 
This bill exemplifies the bipartisan tradition of the House Veterans' 
Affairs Committee, on which I am proud to serve.
  H.R. 3118 continues the efforts of this Congress in honoring our duty 
to care for those who have risked their lives for our country. This 
bill provides the comprehensive eligibility reform that has been needed 
to clarify and correct current law which is complex, confusing, and 
often inconsistent with sound health care practices. By authorizing and 
clarifying eligibility without additional limitations, eliminating 
inpatient restrictions on provision of prosthetic devices, and setting 
sensible priorities for enrollment and registration, H.R. 3118 
significantly improves current law.
  I urge adoption of the bill and yield back the balance of my time.
  Mr. MONTGOMERY. Madam Speaker, I thank my colleagues for their very 
kind remarks today. I urge my colleagues to support this measure.
  Madam Speaker, I yield back the balance of my time.
  Mr. STUMP. Madam Speaker, I yield myself such time as I may consume.
  Once again, as I mentioned, this may be the last time that the VA has 
an opportunity to bring a bill to the floor of this House. I want to 
take this opportunity to thank all the members of the committee for 
their cooperation during this Congress.
  Even on a committee that maintained a truly bipartisan work ethic, 
there were still some scheduling inconveniences and problems that 
Members were asked to endure and I appreciate very much all their 
cooperation. I believe we have a good record of accomplishment to show 
for this Congress.
  Additionally, Madam Speaker, I would like to achkowledge the hard 
work of our committee staff on both sides of the aisle. The bipartisan 
tradition of this committee may start at the top but it is also 
practiced by the staff in their work on all of our bills. We greatly 
appreciate that. I want to thank them very much.
  Mrs. KELLY. Mr. Speaker. I rise today in strong support of H.R. 3118, 
the Veterans' Health Care Eligibility Reform Act. I am a cosponsor of 
this legislation and urge all Members to support it.
  One of the primary responsibilities of our Government is to provide 
for those who have defended our freedoms. In attempting to meet this 
responsibility, the Government has developed a complex, and often 
confusing system of health care eligibility laws. The legislation 
before the House today will help simplify the eligibility requirements 
of veterans, thereby ensuring that needed hospital care and medical 
services will continue to be provided to all veterans who are eligible 
to receive it.
  Mr. Speaker, the issue of veterans health care eligibility is one 
that is very important to me. I have a particular interest in proposed 
changes in the VA health care system because there are two VA medical 
facilities located in the congressional district that I represent. That 
is why I am supporting this legislation. H.R. 3118 will benefit the 
thousands of veterans that use the two facilities in New York's 19th 
Congressional District, and indeed will benefit all veterans around the 
country who depend on the VA to meet their unique health care needs.
  There are a few provisions of the bill that I would like to 
highlight. First, H.R. 3118 will substitute the current single uniform 
eligibility standard of eligibility with a new standard which is 
clinically appropriate and based on a medically sound system of 
priorities. The bill also extend indefinitely the VA's authority to 
provide services to dependents of active-duty and retired service-
members. It clarifies the VA's authority to collect from insurance 
plans of Department of Defense [DOD] beneficiaries cared for in VA 
facilities to the same extent as

[[Page H8776]]

DOD currently recovers for care rendered in its facilities. Most 
importantly, however, the bill authorizes the VA to retain these funds, 
instead of being required to return them to the General Treasury. This 
will provide the VA with additional resources for its use in continuing 
to provide health care to veterans.
  Mr. Speaker, it is vital that we continue to provide veterans with 
the health benefits that they have earned. H.R. 3118 is one more step 
that this Congress has taken to meet this responsibility. I would like 
to thank Chairman Stump for his tireless leadership on veterans issues 
and for bringing this measure to the floor, and I would urge all 
Members to lend H.R. 3118 their support. Thank you.
  Mr. HASTERT. Mr. Speaker, I rise today to support a measure that will 
help provide veterans in Illinois' LaSalle County with outpatient VA 
services.
  LaSalle County veterans have had to travel long distances to receive 
needed VA medical services. This often requires a family member or 
friend to travel with or drive them to their appointments. The Veterans 
Health Care Eligibility Reform Act, will help provide an outpatient VA 
clinic in LaSalle County which will serve over 13,000 eligible veterans 
and their families.
  At a veterans field hearing this past April, Representatives Tim 
Hutchinson, Jerry Weller, Lane Evans, and myself heard the concerns of 
representatives of several organizations who testified to the need for 
a closer outpatient care center. The nearest outpatient care facility 
for eligible LaSalle County veterans is over an hour's drive away, with 
the nearest VA hospital over 2 hours away.
  The measure adopted today authorizes the VA to provide all needed 
outpatient care services, including preventive care and home health 
care, and to contract out for those services where a VA facility does 
not exist.
  This important legislation represents the commitment of Veterans' 
Committee chairman, Bob Stump, the entire House Veterans' Committee, 
and this Congress to keep our promises to our Nation's veterans.
  Our veterans answered the call when our Nation needed them, so 
Congress must answer the call when veterans need our help. Today, we've 
answered that call and I'm proud to support this measure.
  Mr. STEARNS. Mr. Speaker, I rise in support of this legislation today 
which takes the first step toward comprehensive veterans' health care 
reform. Passage of this bill will ensure changes in the tricky 
eligibility rules that currently bar access to health care for our 
Nation's veterans.
  The health care eligibility bill accelerates the shift from expensive 
inpatient care to more cost effective primary and outpatient care. The 
reform is necessary to ensure that the VA refocuses its efforts toward 
assisting those who served our country. Under current VA rules, 
veterans are required to check into hospitals to receive their intended 
treatment. The savings alone from this switch to outpatient care 
services will allow more veterans to have access to the health care 
system.
  The legislation continues the path of decentralization and 
restructures the VA with regard to the management of its health care 
system. By increasing the number of VA partnerships with community 
providers, access to outpatient services, and protecting the VA's 
special disability programs, H.R. 3118 will be a major step in the 
right direction for veterans' health care reform.
  I want to emphasize that this measure is only the first step toward 
achieving health care reform for our veterans. It is imperative that we 
meet this challenge and preserve health care for those who have given 
selflessly to serve our country.
  Mr. BILIRAKIS. Mr. Speaker, I rise in support of H.R. 3118, the 
Veterans' Health Care Eligibility Act. I ask unanimous consent to 
revise and extend my remarks.
  Eligiblity reform is an issue that the Veterans' Affairs Committee, 
the VA and veterans service organizations have been working on for a 
long time. I am a cosponsor of the Veterans' Health Care Eligibility 
Reform Act and am pleased that we are moving this important bill 
forward through the legislative process.
  Today's complex and confusing eligibility criteria represent a 
continuing source of frustration for both veterans and VA personnel. 
Moreover, it is often an impediment to providing veterans with the kind 
of health care they really need.
  As most health care providers move toward a new model of care that 
emphasizes primary and preventive care in outpatient settings, the VA 
must also shift its focus from inpatient to outpatient care. Without 
meaningful eligibility reform, it will be extremely difficult for the 
VA to remain a viable health care provider.
  H.R. 3118 is a step in the right direction for the VA and simplifying 
the VA's eligibility criteria will greatly benefit veterans.
  H.R. 3118 will expand veterans' access to VA care, particularly for 
those with service-connected disabilities or limited means. It will 
eliminate statutory rules which for years have barred the VA from 
providing many veterans with routine outpatient treatment, preventive 
health care services and home care.
  Eligibility reform is long overdue and I urge my colleagues to 
support H.R. 3118.
  Mr. EVERETT. Mr. Speaker I rise today to indicate my strong support 
for H.R. 3118 offered by VA Committee Chairman Stump and our ranking 
member, Sonny Montgomery.
  Mr. Speaker, this important legislation is a giant first step in 
improving access to and the quality of health care provided to our 
veterans. To our many veterans who served in our Armed Forces, who 
loyally and selflessly gave a portion of their lives and the lives of 
their families to protect and defend this country, we owe a debt that 
can never be fully repaid.
  Mr. Speaker, we have a responsibility to meet the health care needs 
of these veterans. H.R. 3118 will enable the VA to restructure and 
prioritize health care delivery and eligibility criteria. Rather than 
continuing to focus on inpatient care, which is not only more expensive 
but is, in most cases, less desirable for the patient, the VA will have 
the flexibility to expand access to outpatient treatment and 
preventative services.
  Mr. Speaker, this element of the bill is especially important for my 
constituents. I represent a majority rural part of southeast Alabama. 
Over 37,000 veterans reside within a 50-mile radius of the city of 
Dothan, AL. These veterans, whether ill, elderly, disabled, or infirmed 
must travel over 100 miles, even 200 miles, to reach a VA medical 
facility. For many, they may wait until their injury or illness has 
reached a dangerous point before they make the trip.
  Mr. Speaker, for years I have worked with the VA to establish an 
outpatient access point around the Dothan area. Certainly, this 
legislation reinforces the priority for such a facility. Quality 
outpatient care, preventative health care services, and reliable home 
care should be readily available and accessible to our eligible 
veterans' population. To this end, we must foster relationships with 
our community health care providers and in turn provide more 
opportunities to meet the needs of our veterans with expanded 
ambulatory treatment services.
  Mr. Speaker, H.R. 3118 goes a long way to meet these goals. Yes, this 
legislation is a first step, but a giant step in the right direction. I 
urge my colleagues to offer their unbridled support for H.R. 3118.
  Mr. STUMP. Madam Speaker, I have no further requests for time, and I 
yield back the balance of my time.
  The SPEAKER pro tempore (Mrs. Myrick). The question is on the motion 
offered by the gentleman from Arizona [Mr. Stump] that the House 
suspend the rules and pass the bill, H.R. 3118, as amended.
  The question was taken.
  Mr. SOLOMON. Madam Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 5 of rule I and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed until disposition of H.R. 2391.

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